2025, Vol. 8, Issue 3, Part A

Background: Endoscopic procedures such as ERCP, EUS, EBUS, and upper GI endoscopy often necessitate airway management under sedation or general anesthesia. In high-risk patients—especially those with ischemic heart disease (IHD), obesity, anticipated difficult airway, or compromised pulmonary reserve—intubation may exacerbate risks due to hemodynamic fluctuations or delayed recovery.

Methods: We present a case series of 10 high-risk patients undergoing endoscopic procedures where THRIVE was used to maintain oxygenation and avoid intubation. Preoperative assessments included airway evaluation and comorbidity optimization. THRIVE was applied via high-flow nasal cannula with continuous monitoring of EtCO?, SpO?, and hemodynamics. Sedation included fentanyl in all cases to provide analgesia and attenuate sympathetic responses.

Results: All procedures were completed successfully without conversion to intubation. No episodes of desaturation, aspiration, or airway obstruction occurred. Patients demonstrated stable hemodynamics, minimal sedation-related complications, and rapid recovery post-procedure. THRIVE provided prolonged apneic oxygenation and CO? washout, even in patients with IHD, morbid obesity, or OSA.

Conclusion: THRIVE, combined with a multimodal sedation regimen including fentanyl, is a safe and effective non-intubating ventilatory strategy for select high-risk patients undergoing endoscopic procedures. It offers excellent oxygenation, reduces pressor response, and avoids the complications associated with airway instrumentation.